Interprofessional empathy: A four-stage model for a new understanding of teamwork

ABSTRACT

Collaboration in healthcare implies that health providers share responsibility and partner with each other in order to provide comprehensive patient care. A review of the empirical literature on teamwork in healthcare settings suggests that the relationships between service providers remain conflictual and variable in commitment to interprofessional collaboration. Recently, social psychologists have given considerable attention to the possibility that empathy could be used to improve intergroup attitudes and relations. Although empathy may be referred to as a means to humanize healthcare practices, few published studies from the healthcare literature focus on the nature of interprofessional empathy. Understanding frameworks different from your own and empathizing with other members of the team is fundamental to collaborative practice. The aim of this study was to understand the nature of empathy among members of interprofessional teams within a hospital environment. This study followed the lived experience of 24 health professionals with their perspective of empathy on interprofessional teams. A two-step procedure was used consisting of semi-structured interviews and depth interviews. Phenomenological data analysis was used to identify common themes and meanings across interviews. From the findings, a four-stage developmental model of interprofessional empathy emerged: Stage 1 is engaging in conscious interactions; Stage 2 requires using dialogical communication; Stage 3 is obtained when healthcare professionals consolidate understanding through negotiating differences between each other; and Stage 4 shows mastery of nurturing the collective spirit. Knowledge of this stage model will provide clinicians with the information necessary to develop awareness of how day-to-day activities within their interprofessional teams influence the development of interprofessional empathy.     

The perceived quality of interprofessional teamwork in an intensive care unit: A single centre intervention study

This article describes a study that evaluated the quality of teamwork in a surgical intensive care unit and assessed whether teamwork could be improved significantly through a tailor-made intervention. The quality of teamwork prior to and after the intervention was assessed using the Interprofessional Practice and Education Quality Scales (IPEQS) using the PROSE online diagnostics and documenting system, which assesses three domains of teamwork: organisational factors, care processes, and team members’ attitudes and beliefs. Furthermore, team members evaluated strengths and weaknesses of the teamwork through open-ended questions. Information gathered by means of the open questions was used to design a tailor-made 12-week intervention consisting of (1) optimising the existing weekly interdisciplinary meetings with collaborative decision-making and clear communication of goal-oriented actions, including the psychosocial aspects of care; and (2) organising and supporting the effective exchange of information over time between all professions involved. It was found that the intervention had a significant impact on organisational factors and care processes related to interprofessional teamwork for the total group and within all subgroups, despite baseline differences between the subgroups in interprofessional teamwork. In conclusion, teamwork, and more particularly the organisational aspects of interprofessional collaboration and processes of care, can be improved by a tailor-made intervention that takes into account the professional needs of healthcare workers.     

Interprofessional teamwork and team interventions in chronic care: A systematic review

To identify key features of teamwork and interventions for enhancing interprofessional teamwork (IPT) in chronic care and to develop a framework for further research, we conducted a systematic literature review of IPT in chronic care for the years 2002–2014. Database searches yielded 3217 abstracts, 21 of which fulfilled inclusion criteria. We identified two more studies on the topic by scanning the reference lists of included articles, which resulted in a final total of 23 included studies. The key features identified in the articles (e.g., team member characteristics, common task, communication, cooperation, coordination, responsibility, participation, staff satisfaction, patient satisfaction, and efficiency) were structured in line with the input–process–output model, and evaluated interventions, such as tools, workshops, and changes in team structure, were added to the model. The most frequently evaluated team interventions were complex intervention programs. All but one of the 14 evaluation studies resulted in enhancement of teamwork and/or staff-related, patient-related, and organization-related outcome criteria. To date, there is no consensus about the main features of IPT and the most effective team interventions in chronic care. However, the findings may be used to standardize the implementation and evaluation of IPT and team interventions in practice and for further research.     

Balancing intertwined responsibilities: A grounded theory study of teamwork in everyday intensive care unit practice

ABSTRACT

This study aimed to describe and explain teamwork and factors that influence team processes in everyday practice in an intensive care unit (ICU) from a staff perspective. The setting was a Swedish ICU. Data were collected from 38 ICU staff in focus groups with registered nurses, assistant nurses, and anaesthetists, and in one individual interview with a physiotherapist. Constant comparative analysis according to grounded theory was conducted, and to identify the relations between the emerged categories, the paradigm model was applied. The core category to emerge from the data was “balancing intertwined responsibilities.” In addition, eleven categories that related to the core category emerged. These categories described and explained the phenomenon’s contextual conditions, causal conditions, and intervening conditions, as well as the staff actions/interactions and the consequences that arose. The findings indicated that the type of teamwork fluctuated due to circumstantial factors. Based on the findings and on current literature, strategies that can optimise interprofessional teamwork are presented. The analysis generated a conceptual model, which aims to contribute to existing frameworks by adding new dimensions about perceptions of team processes within an ICU related to staff actions/interactions. This model may be utilised to enhance the understanding of existing contexts and processes when designing and implementing interventions to facilitate teamwork in the pursuit of improving healthcare quality and patient safety.     

An interprofessional collaborative practice approach to transform heart failure care: An overview

Interprofessional collaborative practice (IPCP) approaches to health care are increasingly recognized as necessary to achieve the Triple Aim—improved health of the population, improved patient care experience, and improved affordability of care. This paper introduces and provides an overview of an interprofessional intervention to improve a healthcare team, healthcare system, and patient outcomes for hospitalized patients with heart failure. In this paper, we describe the overall project resulting from a workforce training grant and the proposed series of future papers resulting from the interprofessional intervention. Collectively, these papers will describe the results of a unique IPCP approach on team, system, and patient outcomes as well as describe and compare organizational and leadership traits that affect collaborative practice. Our hope is that the intervention approaches, evaluation results, and lessons learned described in these papers will help further the efforts to spread IPCP approaches to transforming health care.     

The effectiveness of individual rehabilitation on health status in patients with heart failure: A quasi‐experimental study

Patients with heart failure (HF) live with a serious disease, and need long‐term rehabilitation care. Elements in rehabilitation for patients with HF are based on the recommendations from the European Society of Cardiology and focuses on self‐care and adherence in general. The aim of this study is to test the effect of individually prepared rehabilitation plans measured on health status (HS). The study design is quasi‐experimental. Patients in the control group follow the conventional rehabilitation. For the patients in the intervention group. an individual rehabilitation plan was prepared and followed up by telephone after 4 and 12 weeks. For all patients, HS was measured with Short Form‐36. One hundred sixty‐two patients are included in the study, of which 137 (84.6%) consented. There were no differences in HS before and after the intervention. There are no significant differences by use of a systematically prepared intervention compared with usual care for patients with HF measured on HS 3 months after discharge from the outpatient clinic.     

心力衰竭病人疾病认知水平的调查

[目的 ]了解心力衰竭病人疾病认知水平 ,探讨影响病人对疾病认知水平的因素 ,为深入开展临床护理提供理论依据。 [方法 ]用自行设计的问卷调查表对 82例心力衰竭病人进行疾病诱发因素、临床表现、治疗知识和预防保健知识的问卷调查。 [结果 ]心力衰竭病人对疾病诱发因素、临床表现、治疗知识和预防保健知识正确率分别为 43 .6%、10 .7%、2 5 .0 %和48.5 %。不同文化程度心力衰竭病人在疾病诱发因素、临床表现和治疗知识方面的认知上存在统计学差异(P <0 .0 1) ,不同病程心力衰竭病人在对疾病诱发因素方面的认知上存在统计学差异 (P <0 .0 1)。文化程度高的病人有关疾病知识主要来源于有关书籍 ,文化程度低的病人知识主要来源于医生和护士 ,来源于护士的占3 4.15 % ,排在各种知识来源的首位。[结论 ]对文化程度较高的病人提供有关书籍 ,对文化程度较低的病人以口头交流为主 ,把文化程度低和病程较短的心力衰竭病人作为健康教育的重点对象。     

针对性健康教育对慢性心力衰竭患者的影响

目的了解健康措施对慢性心力衰竭缓解出院患者的影响。方法用logistic回归分析2003年11月-2004年1月住院就诊并缓解出院的80例CHF患者再入院的危险因素;将上述再入院的56例患者按随机化原则分为对照组和观察组,观察组根据多因素分析确定的危险因素采取针对性健康教育措施;对照组不采取健康教育措施;所有病例均随访1年。结果观察组再入院率为18.52%,对照组为51.7%,两者比较,P<0.05;1年后,观察组心功能各项参数均高于对照组(P<0.05)。结论健康教育干预在CHF患者的治疗和康复中起着不可忽视的作用。     

针对性健康教育对慢性心力衰竭患者的影响

目的了解健康措施对慢性心力衰竭缓解出院患者的影响。方法用logistic回归分析2003年11月-2004年1月住院就诊并缓解出院的80例CHF患者再入院的危险因素；将上述再入院的56例患者按随机化原则分为对照组和观察组，观察组根据多因素分析确定的危险因素采取针对性健康教育措施；对照组不采取健康教育措施；所有病例均随访1年。结果观察组再入院率为18.52％？对照组为51．7％，两者比较，P〈0．05；1年后，观察组心功能各项参数均高于对照组（P〈0.05）.结论健康教育干预在CHF患者的治疗和康复中起着不可忽视的作用。     

慢性心力衰竭患者居家护理中的家属护理要求分析

目的观察分析慢性心力衰竭家属的护理要求及相应的护理对策。方法选取该院2013年1月至2014年6月收治的50例慢性心力衰竭患者作为研究对象,通过问卷调查以及面对面交流的方法对患者家属的健康教育需求进行总结分析,并探讨有效的护理对策。结果慢性心力衰竭患者照顾者的健康需求在运动、饮食指导、药物依从性以及心理护理方面存在一定的缺陷,而其主要的护理需求集中在治疗效果以及药物的注意事项方面,经过积极的护理干预后,患者家属对护理的满意度达到100%。结论慢性心力衰竭患者家属的护理需求主要集中在患者的治疗效果以及药物的依从性方面,需要给予针对性的护理干预。     

Perceived benefits of the disease: A qualitative study of patients' experiences of heart failure

Heart failure may bring about positive outcomes, which have not been adequately addressed in the literature. Therefore, this qualitative study sought to scrutinize the experiences of patients and the perceived positive effects of heart failure. The opinions of 19 patients with heart failure in Mashhad city (Iran) were collected via semistructured interviews from December 2017 to November 2018. After analyzing the data, six themes were identified by framework analysis: healthy lifestyle, effective interactions, appreciation of life, spirituality, reappraisal of life and priorities, and endurance. Such positive effects may lead to empowerment and better coping of patients with the disease. Therefore, nurses should consider the patients' perception of illness in addition to the disease manifestations and offer training focusing on the possibilities instead of limitations.     

Development of self-care educational material for patients with heart failure in Japan: a pilot study

This study assessed the need for information regarding heart failure and self-care, developed self-care educational material, and investigated the feasibility of the material. A total of 22 hospitalized heart failure patients (mean age: 63 years) completed a self-administered questionnaire. We found that more than 90% of patients desired information, particularly about heart failure symptoms, time to notify healthcare providers, prognosis, and exercise/physical activity. After examining the eight existing brochures for Japanese heart failure patients, we developed self-care educational material. This was based on heart failure guidelines and on the results of our inquiry regarding information needs. Finally, a pilot study was conducted in nine hospitalized heart failure patients (mean age: 57 years). None of the patients had difficulty reading or understanding the educational material. The self-administrated questionnaire survey revealed that comprehension of the following improved after the educational sessions with the material: heart failure symptoms, medication, weighing, sodium intake, and fluid intake (P < 0.05). In conclusion, heart failure patients have a great need for information about heart failure. Our pilot study suggests that the material was readable and had a beneficial effect on heart failure comprehension.     

多方位护理在慢性心力衰竭合并低钠血症患者治疗中的应用

目的探讨多方位护理在慢性心力衰竭合并低钠血症患者治疗中的应用。方法选取108例慢性心力衰竭合并低钠血症患者按随机数字表法分成观察组和对照组,各54例。对照组实行常规护理,观察组采用多方位护理。对比2组的治疗效果、血钠恢复正常时间、住院时间及护理前、后心功能。结果观察组治疗的总有效率高于对照组(P0.05);观察组血钠恢复正常时间及住院时间均短于对照组(P0.05);2组护理前心功能各指标无差异,观察组护理后左室收缩末内径(LVSD)和左室舒张末内径(LVDD)均低于对照组(P0.05);观察组护理后左室射血分数(LVEF)高于对照组(P0.05)。结论多方位护理能有效提高慢性心力衰竭合并低钠血症患者的治疗效果,并缩短治疗时间和改善心功能。     

慢性心力衰竭病人自我护理认知的调查

[目的]了解慢性心力衰竭病人自我护理认知水平状况,以便于更有针对性的进行相关的健康教育。[方法]对98例慢性心力衰竭病人进行问卷调查。[结果]慢性心力衰竭病人自我护理维持较好的行为是遵医嘱服药94.5%,而对病情变化的观察接近70%不知道,对所服药物的主要副反应及其自我观测指标78.6%不知道。[结论]自我护理维持在中等水平以上,而自我护理管理较差。提示慢性心力衰竭病人的健康教育,不但住院期间,还需要在门诊甚至延续到社区,通过反复多次的、连续系统地对病人进行。